Responsibilities:
Investigate and resolve complex denial issues.
Analyze denial trends to identify opportunities for process improvement.
Initiate and lead payer calls for escalated denial inquiries, follow-ups, and disputes.
Develop and implement strategies to reduce denial rates and enhance reimbursement.
Collaborate with internal stakeholders to address root causes of denials.
Prepare and submit appeals for denied claims as needed.
Maintain comprehensive documentation of denial activities and outcomes.
Address denials at the root cause by requesting appropriate rules and system edits after partner approval.
Identify and analyze denial trends and escalate to supervisor for further resolution.
Requirements:
Bachelor’s degree in any discipline.
Strong problem-solving and analytical skills and work towards resolution.
Candidates with 1-2 years of experience in Accounts Receivable (AR) & Denial Management
Qualifacts is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
Celebrating 25 years, Qualifacts is the leading provider of electronic health record (EHR) software and data solutions designed specifically for behavioral health and human services organizations. Putting the health of individuals first, our award-winning platforms—Credible, CareLogic, and InSync—enable behavioral health providers to spend more time on what matters most: delivering superior care that drives better outcomes. Qualifacts is more than a provider of innovative technology—we're partners in care, working alongside organizations of all sizes nationwide to simplify the lives of behavioral health providers and provide care with the greatest need. We simplify clinical workflows and ensure compliance, while strengthening client-provider relationships. Today, we serve more than 2,700 organizations across all 50 states, including 33% of the nation's Certified Community Behavioral Health Centers (CCBHCs).
